About 3,000 people in the United States are kept alive with a mechanical heart pump. They’re either waiting for a heart transplant or living with that pump for the rest of their lives.
But what if one of these patients goes into cardiac arrest? Proceeding with CPR on these patients was once considered to be fatal — but not anymore.
Hartford Hospital heart failure/transplant specialist Dr. Jason Gluck explains:
Q: Why was performing CPR on a patient with a heart pump once considered dangerous?
A: The body needs two things to survive: air to go in and out, and blood to go round and round. A Left Ventricular Assist Devices (LVAD) helps by allowing the heart to pump blood through two big tubes, about the size of a garden hose. One tube sits in the main pumping chamber of the heart, the left ventricle. This provides blood flow into the pump. The second tube goes from the pump into the main artery leaving the heart supplying blood to the body, the aorta. It is important to note that, with exception of the total artificial heart, these pumps do not replace the heart, but assist it, so that if the pump stops, there is an opportunity for the native heart to still work, and send blood round and round.
The standard of care for cardiac arrest is to perform chest compressions — an important part of CPR. We have all seen it on just about every TV show or movie at one point or another. With regard to patients with LVADs, the teaching on what to do if a such a patient suffers cardiac arrest has been controversial, with differing opinions on whether or not to perform chest compressions. This is due to a fear of dislodging one of the LVAD tubes in the heart, which can cause massive bleeding. Therefore, some hospitals would instruct their providers, “under no circumstances should you perform chest compressions,” while others would teach, “it’s OK to perform chest compressions if needed.”
In the United States, well over 15,000 LVADs have been implanted in humans as either a bridge to transplant (while a patient waits for heart transplant) or as a tool to extend one’s life without a transplant. Over 100 of those implants have happened at Hartford Hospital and we currently have over 40 patients on support and in the community. The possible dangers of CPR performed on these patients became an important issue for us.
Q: You have developed a medical device to help first responders identify and treat patients with LVADs. How did this come about?
A: I have a background as a firefighter and a paramedic, and I used to see these folks on a regular basis and saw the need for more training on this particular situation. So I worked to create the VLAD and HVLAD, which are two medical simulators with different types of LVAD heart pumps in them. I created these in my garage, and they look and feel similar to a regular CPR Annie (a mechanical doll used for basic CPR training certification). These are now used at the Hartford Hospital Center for Education, Simulation and Innovation (CESI) to educate our patients, staff and EMS personnel on how to treat patients with LVADs in emergent situations.
Q: You recently co-chaired an in-depth report for the American Heart Association on this topic. What did the report entail and how will it be used?
A: This report, published in the medical journal Circulation, gives me great pride. It gives clarity to providers at all levels about how and when chest compressions are safe to provide in cardiac arrest in LVAD patients. When we created this paper, we designed it to apply at all levels, including bystanders, emergency medical dispatchers, EMTs/Paramedics, and advanced care providers as well as medical healthcare providers.
Importantly, it sets a standard based on evidence-based medicine that the default in cardiac arrest should be to provide chest compressions. It is only under very unique circumstances, when able to monitor hemodynamics carefully, that it is considered safe to withhold chest compressions.
The take-home message, however, is that chest compressions SHOULD be performed on LVAD patients unless otherwise directed by an LVAD specialist.
Learn more about heart transplantation services at Hartford Hospital here.